Surgical bowel retractor devices

ABSTRACT

Bowel retractor devices. In various forms, the bowel retractor devices are configurable from a collapsed position wherein the retractor may be inserted through a trocar cannula or other opening in a patient&#39;s body to a second expanded position wherein at least a portion of the patient&#39;s bowel may be advantageously supported in a desired position.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application claiming priority under35 U.S.C. § 120 to U.S. patent application Ser. No. 15/273,358, entitledCOLLAPSIBLE ANVIL PLATE ASSEMBLIES FOR CIRCULAR SURGICAL STAPLINGDEVICES, filed Sep. 22, 2016, now U.S. Patent Application PublicationNo. 2017/0007229, which is a continuation application claiming priorityunder 35 U.S.C. § 120 to U.S. patent application Ser. No. 14/788,923,entitled SURGICAL BOWEL RETRACTOR DEVICES, filed Jul. 1, 2015, whichissued on Nov. 20, 2018 as U.S. Pat. No. 10,130,352, which is acontinuation application claiming priority under 35 U.S.C. § 120 to U.S.patent application Ser. No. 13/181,827, entitled SURGICAL BOWELRETRACTOR DEVICES, filed Jul. 13, 2011, which issued on Jul. 28, 2015 asU.S. Pat. No. 9,089,330, which claims the benefit of and priority under35 U.S.C. § 119(e) to U.S. Provisional Patent Application Ser. No.61/452,432, filed Mar. 14, 2011, entitled SURGICAL STAPLING INSTRUMENTS,the entire disclosures of which are hereby incorporated by referenceherein.

FIELD OF THE INVENTION

The present invention generally relates to surgical devices fortemporarily retaining and supporting tissues and organs in a desiredorientation during surgery, and more particularly, to devices forretracting portions of the bowel during surgery.

BACKGROUND

One major challenge to employing laparoscopic colorectal techniques isthe ability to move all of the unrelated or non-involved tissue out ofthe surgical site to permit better physical and visual access to thetarget tissue or organ. In an open procedure, large metal retractorswould be used to pull the masses of small intestines away and then packthem off with surgical sponges. When performing various colorectalsurgical procedures, the surgeon often must manipulate the surgicalinstruments through a pile or collection of bowel to open up a window tooperate in.

Thus, the need exists for devices that can be used to support portionsof the bowel during laparoscopic colorectal operations in unobtrusiveorientations to provide better physical and visual access to the portionof the bowel to be operated on.

The foregoing discussion is intended only to illustrate some of theshortcomings present in the field of the invention at the time, andshould not be taken as a disavowal of claim scope.

BRIEF SUMMARY

In connection with general aspects of various embodiments of the presentinvention, there is provided a bowel retractor device that, in variousforms, comprises an elastic body that is configurable from a firstcollapsed position wherein the elastic body is insertable through anopening in a patient's body to a second expanded position wherein aportion of the patient's bowel may be supported by a central portion ofthe elastic body in a desired orientation.

In connection with yet another general aspect of one form of the presentinvention, there is provided a bowel retractor device that includes acentral portion that has a first plurality of flexible first armsprotruding therefrom in a first direction. The plurality of firstflexible arms defines a first opening between each adjacent flexiblearm. A second plurality of flexible second arms protrude from thecentral portion in a second direction wherein each flexible second armprotrudes from the central portion at positions opposite from the firstopenings and wherein the flexible second arms are spaced from each otherto form a second opening therebetween.

In accordance with still another general aspect of one form of thepresent invention, there is provided a bowel retractor device thatincludes a selectively inflatable ring that has a textured annularsurface that defines an interior area. A supply conduit is coupled tothe selectively inflatable ring and a source of pressurized medium.

In accordance with other general aspects of various forms of the presentinvention, there is provided a method for performing laparoscopic bowelsurgery on a target portion of a patient's bowel. In one form of thepresent invention, the method includes inserting at least one bowelretractor device through an opening in the patient. Each of the bowelretractor devices comprises a body that is configurable from a firstcollapsed position wherein the body is insertable through the opening toa second expanded position. The method further includes engaging acorresponding non-target portion of the bowel with a central portion ofeach of the at least one bowel retractor devices when in the secondexpanded position and positioning the at least one bowel retractordevice to locate the corresponding non-target bowel portion engagedthereby in non-obtrusive positions to thereby provide physical andvisual access to the target portion of the bowel.

BRIEF DESCRIPTION OF THE FIGURES

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the invention,and, together with the general description of the invention given above,and the detailed description of the embodiments given below, serve toexplain the principles of the present invention.

FIG. 1 is a view of a portion of a patient's abdomen and bowel segmentwith two trocars installed through the abdominal wall and one of thebowel retraction device embodiments of the present invention withnon-target portions of the patient's bowel installed therein;

FIG. 2 is a perspective view showing a conventional trocar installedthrough the abdominal wall of a patient and being used to pass a bowelretractor embodiment of the present invention into a surgical areawithin the abdomen;

FIG. 3 is a view of a bowel retractor embodiment of the presentinvention inserted in a twisted orientation into a cannula of a trocar;

FIG. 4 is a top view of a bowel retractor device embodiment of thepresent invention;

FIG. 5 is a top view of another bowel retractor device embodiment of oneform of the present invention;

FIG. 6 is a perspective view of another bowel retractor deviceembodiment with non-target portions of a patient's bowel supportedtherein;

FIG. 7 is another perspective view of a bowel retractor device locatedinside a patient's abdomen and wherein the surgeon is using a graspingdevice to pull non-target portions of the patient's bowel through anopening in the bowel retractor device;

FIG. 8 is a top view of another bowel retractor device embodiment of thepresent invention;

FIG. 9 is a perspective view of the bowel retractor device of FIG. 8supporting non-target portions of a patient's bowel therein;

FIG. 10 is a front perspective view of another bowel retractor deviceembodiment of the present invention;

FIG. 11 is a perspective view of the bowel retractor device of FIG. 10supporting non-target portions of a patient's bowel therein and whereinthe tether portion thereof has be inserted through the cannula of atrocar;

FIG. 12 is a top view of another bowel retractor device embodiment ofthe present invention;

FIG. 13 is a perspective view of the bowel retractor device of FIG. 12supporting non-target portions of a patient's bowel therein and whereinthe tether portion thereof has be inserted through the cannula of atrocar;

FIG. 14 is a perspective view of another bowel retractor deviceembodiment of the present invention;

FIG. 15 is a perspective view of the bowel retractor device of FIG. 14supporting non-target portions of a patient's bowel therein and whereinretractor manipulation needles have been inserted through the abdominalwall to engage portions of the bowel retractor device;

FIG. 16 is a perspective view of another bowel retractor deviceembodiment of the present invention;

FIG. 17 is another perspective view of the bowel retractor deviceembodiment of FIG. 16 with a non-target portion of a patient's bowelbeing supported thereby;

FIG. 18 is a cross-sectional view of the bowel retractor deviceembodiment of FIG. 16;

FIG. 19 is a partial perspective view of another bowel retractor deviceembodiment of the present invention;

FIG. 20 is a side view of another bowel retractor device embodiment ofthe present invention;

FIG. 21 is a perspective view of the bowel retractor device embodimentof FIG. 20 with portions of a patient's bowel supported therein;

FIG. 22 is a top view of another bowel retractor device embodiment ofthe present invention;

FIG. 23 is a perspective view of the bowel retractor device embodimentof FIG. 22 inside a portion of a patient's abdomen and supporting anon-target bowel portion therein;

FIG. 24 is a perspective view of another bowel retractor deviceembodiment of the present invention;

FIG. 25 is a perspective view of another bowel retractor deviceembodiment of the present invention;

FIG. 26 is a perspective view of another bowel retractor deviceembodiment of the present invention;

FIG. 27 is a perspective view of a trocar device inserted through theabdominal wall of a patient with a bowel retractor device embodimentbeing passed through the trocar cannula;

FIG. 28 is a perspective view of a portion of a patient's colon withfour bowel retractor device embodiments of the present inventionsupporting non-target bowel portions;

FIG. 29 is a partial perspective view of another bowel retractor deviceembodiment of the present invention being supported in an expandedposition by an installation tool embodiment of the present invention;

FIG. 30 is another perspective view of the bowel retractor deviceembodiment of FIG. 29 supporting a bowel portion therein with theinstallation tool removed therefrom;

FIG. 31 is a perspective view of a portion of a patient's colon withfour other bowel retractor device embodiments of the present inventionsupporting non-target bowel portions;

FIG. 32 is a perspective view of another bowel retractor deviceembodiment of the present invention in an open position and supported bya grasping instrument;

FIG. 33 is another perspective view of the bowel retractor deviceembodiment of FIG. 32 and supporting a bowel portion therein;

FIG. 34 is a partial perspective view of a trocar device insertedthrough a portion of a patient's abdominal wall with the bowel retractordevice of FIGS. 32 and 33 being inserted through the trocar cannula;

FIG. 35 is a top view of the bowel retractor device embodiment of FIGS.32-34 in a collapsed or rolled-up position wherein the retractor devicemay be inserted through a trocar cannula or other opening in a patient'sbody;

FIG. 36 is a perspective view of three bowel retractor deviceembodiments of FIGS. 32-35 inside a portion of a patient's abdomen;

FIG. 37 is a perspective view of a patient's abdomen and bowel retractordevice embodiments of the present invention supporting portions of thepatient's bowel therein;

FIG. 38 is a perspective view of a patient's abdomen and bowel retractordevice embodiments of the present invention supporting portions of thepatient's bowel therein;

FIG. 39 is a top view of one of the bowel retractor devices depicted inFIG. 38 in a closed position;

FIG. 40 is another top view of the bowel retractor device of FIGS. 38and 39 in an open position;

FIG. 41 is a partial perspective view of another bowel retractor deviceembodiment of the present invention supporting a portion of a patient'sbowel therein;

FIG. 42 is a partial perspective view of another bowel retractor deviceembodiment of the present invention supporting a portion of a patient'sbowel therein;

FIG. 43 is a perspective view of a portion of another bowel retractordevice embodiment of the present invention in an uninflated state;

FIG. 44 is another perspective view of the portion of bowel retractordevice embodiment of FIG. 43 in an inflated state;

FIG. 45 is a partial perspective view of a portion of a patient'sabdomen supporting the bowel retractor device embodiment of FIG. 43therein in an uninflated state; and

FIG. 46 is another partial perspective view of a portion of a patient'sabdomen containing the bowel retractor device embodiment of FIG. 44therein and supporting a portion of the patient's bowel therein.

DETAILED DESCRIPTION

The assignee of the present application also owns the followingapplications which were contemporaneously filed herewith on Jul. 13,2011 and which are each herein incorporated by reference in theirrespective entireties:

-   -   U.S. patent application Ser. No. 13/181,779, entitled MULTIPLE        PART ANVIL ASSEMBLIES FOR CIRCULAR SURGICAL STAPLING DEVICES,        now U.S. Pat. No. 9,125,654;    -   U.S. patent application Ser. No. 13/181,798, entitled MODULAR        SURGICAL TOOL SYSTEMS, now U.S. Pat. No. 9,113,884;    -   U.S. patent application Ser. No. 13/181,801, entitled SPECIMEN        RETRACTION DEVICES AND METHODS, now U.S. Pat. No. 8,632,462;    -   U.S. patent application Ser. No. 13/181,807, entitled MODULAR        OCCLUSION AND TISSUE ACQUISITION MECHANISMS FOR CIRCULAR        STAPLING DEVICES, now U.S. Pat. No. 8,827,903;    -   U.S. patent application Ser. No. 13/181,831, entitled TISSUE        MANIPULATION DEVICES, now U.S. Pat. No. 8,858,590;    -   U.S. patent application Ser. No. 13/181,768, entitled        COLLAPSIBLE ANVIL PLATE ASSEMBLIES FOR CIRCULAR SURGICAL        STAPLING DEVICES, now U.S. Pat. No. 9,113,883;    -   U.S. patent application Ser. No. 13/181,786, entitled CIRCULAR        STAPLING DEVICES WITH TISSUE-PUNCTURING ANVIL FEATURES, now U.S.        Pat. No. 9,033,204;    -   U.S. patent application Ser. No. 13/181,774, entitled ANVIL        ASSEMBLIES WITH COLLAPSIBLE FRAMES FOR CIRCULAR STAPLERS, now        U.S. Pat. No. 8,978,955;    -   U.S. patent application Ser. No. 13/181,842, entitled RECTAL        MANIPULATION DEVICES, now U.S. Pat. No. 8,734,478; and    -   U.S. patent application Ser. No. 13/181,836, entitled SURGICAL        ACCESS DEVICES WITH ANVIL INTRODUCTION AND SPECIMEN RETRIEVAL        STRUCTURES, now U.S. Pat. No. 9,211,122.

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those of ordinary skill in the art will understand that thedevices and methods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the various embodiments of the present invention is definedsolely by the claims. The features illustrated or described inconnection with one exemplary embodiment may be combined with thefeatures of other embodiments. Such modifications and variations areintended to be included within the scope of the present invention.

Reference throughout the specification to “various embodiments,” “someembodiments,” “one embodiment,” or “an embodiment”, or the like, meansthat a particular feature, structure, or characteristic described inconnection with the embodiment is included in at least one embodiment.Thus, appearances of the phrases “in various embodiments,” “in someembodiments,” “in one embodiment”, or “in an embodiment”, or the like,in places throughout the specification are not necessarily all referringto the same embodiment. Furthermore, the particular features,structures, or characteristics may be combined in any suitable manner inone or more embodiments.

The terms “proximal” and “distal” are used herein with reference to aclinician manipulating the handle portion of the surgical instrument.The term “proximal” referring to the portion closest to the clinicianand the term “distal” referring to the portion located away from theclinician. It will be further appreciated that, for convenience andclarity, spatial terms such as “vertical”, “horizontal”, “up”, and“down” may be used herein with respect to the drawings. However,surgical instruments are used in many orientations and positions, andthese terms are not intended to be limiting and/or absolute.

FIG. 1 illustrates a portion of a patient's abdominal wall 2 andportions of the patient's bowel or colon 4. More specifically, a bowelretractor device 20 embodiment of the present invention is employed tosupport/retract non-target bowel portions 8 from target bowel portions6. As used herein, the term “target bowel portion(s)” refers to thatportion or portions of the bowel on which the surgical procedure is tobe performed. The term “non-target bowel portions” refers to thoseportions of the bowel that are not the subject of the surgical procedureand which often obscure physical and/or visual access to the targetportions. In the depicted Figure, two conventional trocar devices 10have been inserted through the abdominal wall 2. Such trocar devices 10include a cannula 12 that is configured to form of a passage through theabdominal wall 2 through which surgical instruments 14 may be inserted.A variety of styles and sizes of trocars are known. In general, thetrocars are sized based on the inner diameter of their respectivecannula.

In various non-limiting embodiments, the bowel retractor device 20comprises an elastic body portion 22 that is configurable from a firstcollapsed orientation that permits the elastic body portion 22 to beinserted through a trocar cannula 12 to a second expanded positionwherein a non-target portion or portions 8 of a patient's bowel 4 aresupported by a central portion 24 of the bowel retractor device 20. Invarious embodiments, the central portion 24 may comprise a substantiallyflexible film such as for example silicone or neoprene film having athickness ranging from, for example, 0.020 inches to 0.120 inches thathas a collar or flexible outer ring 26 formed therearound. The flexibleouter ring 26 may comprise for example in at least one embodiment, anembedded stainless steel wire or titanium wire. In at least oneembodiment, when the retractor device 20 is in the first or collapsedposition, it is in a twisted configuration such as those shown in FIGS.2 and 3. When the retractor device 20 is in the second or expandedposition, the retractor device 20 may assume the positions shown inFIGS. 1, 4, and 5. The flexible central portion 24 has a first amount ofelasticity and the flexible outer ring 26 has a second amount ofelasticity. In some embodiments, the second amount of elasticity is lessthan the first amount of elasticity. That is the outer ring 26 may bemore rigid that the flexible central portion 24.

As can be seen in FIGS. 4 and 5, the central portion 24 of the bowelretractor device 20 has at least one opening 28 therein. The size,shape, number, and orientation(s) of such opening(s) may vary. Forexample, in FIG. 4, the opening 28 comprises an elongated slot and theopening 28 in FIG. 5 has a multiple-pointed star shape.

The retractor devices 20 may be used as follows in connection with oneexemplary method of the present invention. To commence the surgicalprocess, at least two trocars 10 are installed through the patient'sabdominal wall 2 in a known manner. One of the trocars 10 may beinitially used to pass the retractor device or devices 20 therethrough.The other trocar 10 may be used to enable the surgeon to pass aconventional surgical instrument such as a grasper 14 to grab theretractor device 20 and position it over the non-target bowel portions8. Once the retractor device 20 has exited the trocar cannula 12, thesurgeon may also use that trocar 10 to pass a second grasper 14therethrough to assist in drawing the non-target portions 8 of bowelthrough the opening(s) 28 in the retractor device 20. Such arrangementenables the non-target bowel portions 8 to be retained away from thetarget bowel portions 6. By introducing three or four of the retractordevices 20, for example, multiple quadrants of non-target bowel portions8 could be tucked away and easily movable to clear the surgical site.The coupled group could be pulled en masse to one side or the other ofthe target bowel portion(s) 6 making it very easy to negotiate themultiple bowel quadrants to perform the surgical procedure on the targetbowel portions 6. In various embodiments, the surgeon may pull onesection 8 of bowel 4 multiple times through the opening 26 to bunch upand constrain that non-target portion 8 of the bowel 4.

In some embodiments, the outer ring or collar 26 may be bendable asopposed to being purely elastic. For example, in some embodiments, thecollar 26 may comprise a bendable metal wire or cable that isencapsulated in a flexible material such as silicone, neoprene, etc. Insuch arrangement, the surgeon may bend or twist the collar or outer ring26 into a desired configuration and the metal wire will retain it inthat configuration. Once the retractor device 20 has been fully insertedinto the patient, the surgeon may bend the retractor device 20 intowhatever restraining form that would be most useful to keep the clump ofnon-target bowel 8 out of the working space. For example, the retractordevice 20 may be folded or bent and then lodged up behind the trocarcannula 12 or held back with a grasping instrument 14, whichever is moreconvenient. The flexible fit holds the non-target bowel portion 8together without strangulating it or interfering with the peristalsiswhich might cause swelling. The fit between the non-target portion(s) 8pulled through the opening(s) is such that the non-target bowelportion(s) would not slip back out of the opening 28.

FIGS. 6 and 7 illustrate bowel retractor devices 20 with alternativeopening arrangements. In particular, the openings 28 comprises aplurality of slots and perforations 29. The perforations 29 are alignedoff of each end of the slots 28 as shown and enable the flexible centerportion 24 to rupture to enable the slots 28 to enlarge or expand asneeded as the bowel portions 8 are pulled therethrough. In FIGS. 7 and8, those slots that have expanded are designated as slots “28E”.

FIG. 8 illustrates another retractor device 30 embodiment of the presentinvention that includes a body portion 32 that is configurable from afirst collapsed orientation that permits the body portion 32 to beinserted through a trocar cannula or other opening in a patient's bodyto a second expanded position wherein a non-target portion or portions 8of a patient's bowel 4 are supported by a central portion 34 of thebowel retractor device 30. In various embodiments, the central portion34 may comprise a substantially flexible film such as, for example, asilicone or neoprene film having a thickness ranging from, for example,0.020 inches to 0.120 inches that has a collar or flexible outer ring 36formed therearound. As can be seen in FIG. 8, the outer collar 36 isformed with a plurality of spaced radially outwardly extending tabs 38.Each tab 38 has a hole 40 therethrough that is configured to receive acinchable member 42 such as, for example, a vectran, nylon, polyglycolicacid (PGA), catgut, or polypropylene cable to be woven therethrough asshown. The end portions 43, 44 of the cinchable member 42 pass through agrommet portion 39 of the collar 36. By applying tension “T” to the endportions 43, 44 will cause the bowel retractor 30 to be cinched aroundthe non-target bowel portions 8 pulled through an opening 35 in thecentral portion 34. The cinchable member 42 may also be used tomanipulate the retractor 30 and retrain it in a desired position.

In FIG. 9, the bowel retractor device 50 is substantially similar to thebowel retractor device 30, except that the bowel retractor device 50lacks the cinchable member. Instead a flexible tether 52 extends fromthe device 50. The tether has a manipulation ring 54 attached thereto asshown. The outwardly extending tabs 38 form portions of the device 50that may be easily grasped with a grasping instrument to facilitate theinstallation, manipulation and positioning of the bowel retractor device50.

FIGS. 10 and 11 illustrate another bowel retractor device embodiment 60of the present invention. The bowel retractor 60 includes an elasticbody portion 62 that comprises a flexible plate member 63 that has aplurality of openings 64, 66, 68 therethrough. In various embodiments,the flexible plate member 63 may comprise, for example, a silicone orneoprene film having thicknesses that range from 0.020 inches to 0.150inches. In the illustrated embodiment, three different sizes of openingsare shown. In other embodiments, all of the openings may have the samesize and/or have different shapes. The scope of this embodiment of thepresent invention is intended to cover embodiments with a variety ofdifferently-shaped openings and different arrangements ofopenings—having the same size and having different sizes. As can befurther seen in FIGS. 10 and 11, a tether 70 is attached to otherotherwise formed with the body portion 62 such that it protrudestherefrom. In addition, a retention tab or portion 72 is also formed onor attached to the body portion 62. In the illustrated embodiment, thebody portion 62 is substantially square-shaped and the tether 70 andretention tab 72 are formed on opposite corners of the plate member 63.

The bowel retractor device 60 may be used as follows. After the device60 has been inserted through the trocar 10 or otherwise located at thesurgical site, the surgeon may use graspers or other surgicalinstruments to draw the non-target portions 8 of the patient's bowel 4through one or more of the openings 64, 66, 68 in the body portion 62 inthe manner described above. Once the non-target bowel portion(s) 8 havebeen drawn through one or more of the openings 64, 66, 68 the surgeonmay loop the tether 70 through an opening 74 in the retention tab 72 andextend the tether 70 back through the trocar cannula 12 to enable thesurgeon to retain, manipulate and/or position the retractor device 60and retained non-target bowel portion(s) 8 from outside of the patient.

FIGS. 12 and 13 illustrate another bowel retractor device embodiment 80of the present invention. As can be seen in FIG. 12, in at least oneembodiment, the device 80 comprises a plurality of (four are shown) offlexible plate members 82 that are interconnected by flexible straps 84.Each plate member 82 has at least one (two are shown) openings 83therein. The openings 83 shown have a multiple pointed star shape. Thenumber, shape and orientation of openings 83 may vary. One or more platemembers 82 may have different numbers of differently shaped openings inarrangements that differ from the openings and arrangements in one ormore other plate members 82. In still other embodiments, at least oneplate member 82 has at least one opening 83 therethrough. As can also beseen in FIG. 12, a tether 86 is attached to, or is other otherwiseformed with, one of the plate members 82 such that it protrudestherefrom. In addition, a retention strap 88 is attached to, or isotherwise formed with, another plate member 82. In the illustratedembodiment, the four plate members 82 are shown and the tether 86 andretention strap 72 are formed on the corners of opposite plate members82.

The bowel retractor device 80 may be used as follows. After the device80 has been inserted through the trocar 10 or otherwise located at thesurgical site, the surgeon may use graspers or other surgicalinstruments to draw the non-target portions 8 of the patient's bowel 4through one or more of the openings 83 in the plate members 82 in themanner described above. Once the non-target bowel portion(s) 8 have beendrawn through one or more of the openings 83, the surgeon may loop thetether 86 through an opening 90 in the retention strap 88 and extend thetether 86 back through the trocar 10 to enable the surgeon to retain,manipulate and/or position the device and retained non-target bowelportion(s) 8 from outside of the patient.

FIGS. 14 and 15 illustrate another bowel retractor embodiment 100 of thepresent invention. The bowel retractor 100 includes a body portion 102that comprises a flexible mesh portion that has a plurality of openings104 therethrough. In various embodiments, the body portion may befabricated from, for example, silicone, neoprene, etc. In theillustrated embodiment, openings 104 may be are arranged in a grid-likefashion. In other embodiments, the openings may have different sizes.The scope of this embodiment of the present invention is intended tocover embodiments with a variety of differently-shaped openings anddifferent arrangements of openings—having the same size and havingdifferent sizes. As can be further seen in FIGS. 14 and 15, at least onemanipulation formation 106 is formed on the body portion 102. In theillustrated embodiment, the device 100 is substantially square-shapedand a manipulation formation 106 is formed on each corner thereof. Eachmanipulation formation 106 has a hole 108 therethrough to enable amanipulation tool to engage and manipulate the device 100. Themanipulation tool may comprise a grasper or other surgical instrument.In the illustrated embodiment, two needle-like hook members 110 areinserted through the patient's abdominal wall and serve to hook theopenings 108 in the manipulation formations 106.

The bowel retractor device 100 may be used as follows. After the device100 has been inserted through the trocar 10 or otherwise located at thesurgical site, the surgeon may use graspers or other surgicalinstruments to draw the non-target portions 8 of the patient's bowel 4through one or more of the openings 104 in the body portion 102 in themanner described above. Once the bowel portions 8 have been drawnthrough one or more of the openings 104, the surgeon may insert one ormore of the needle-like hook members 110 through the abdominal wall 2 tohookingly engage one or more of the manipulation formations 106 toposition and or retain the device 100 in a desired orientation.

FIG. 16 illustrates another bowel retractor device embodiment 120 of thepresent invention. The bowel retractor device 120 includes a bodyportion 122 that comprises a flexible annular ring 124 that has aflexible central portion 126 attached thereto. In at least oneembodiment, the flexible central portion 126 comprises a plurality ofinterwoven flexible ribbon-like members 128. In various embodiments, theflexible annular ring may be fabricated from, for example,Polypropylene, Santoprene, etc. The interwoven ribbon members 128 willhave weave tightness that permits non-target portion(s) 8 of thepatient's bowel to be pulled therethrough without damaging the bowel,yet retain the non-target bowel portion(s) in position. To assist thesurgeon with the manipulation and support of the device 120, amanipulation formation 129 may be formed on the annular ring 124 asshown.

The bowel retractor device 120 may be used as follows. After the device120 has been inserted through the trocar 10 or otherwise located at thesurgical site, the surgeon may use graspers or other surgicalinstruments to draw the non-target portions 8 of the patient's bowel 4between the ribbons 128 in the manner described above. Once the bowelportions 8 have been drawn between the ribbons 128, the surgeon may usea grasper or other surgical instrument to engage the manipulationformation 129 to position and or retain the device 120 in a desiredorientation.

FIG. 17 illustrates another bowel retractor device embodiment 130 of thepresent invention. The bowel retractor device 130 includes a bodyportion 132 that comprises a flexible annular ring 134 that has aflexible central portion 136 attached thereto. In at least oneembodiment, the flexible central portion 136 comprises a plurality ofinterwoven flexible strips 138. In various embodiments, the flexibleannular ring 134 may be fabricated from, for example, Santoprene,polypropylene, etc. In at least one embodiment, the interwoven flexiblestrips 138 have a substantially circular cross-sectional shape. Theinterwoven strips 138 define a plurality of openings 139 and will haveweave tightness that permits non-target portion(s) 8 of the patient'sbowel 4 to be pulled through one or more of the openings 139 withoutdamaging the bowel, yet retain the bowel in position. To assist thesurgeon with the manipulation and support of the device 120, amanipulation formation (not shown) may be formed on the annular ring 134as shown.

The bowel retractor device 130 may be used as follows. After the device130 has been inserted through the trocar 10 or otherwise located at thesurgical site, the surgeon may use graspers or other surgicalinstruments to draw the non-target portions 8 of the patient's bowel 4through one or more of the openings 139 in the manner described above.Once the non-target bowel portion(s) 8 have been drawn between theflexible strips 138, the surgeon may use a grasper or other surgicalinstrument to engage the manipulation formation to position and orretain the device 130 in a desired orientation.

FIG. 18 illustrates another bowel retractor device embodiment 140 of thepresent invention which is substantially similar to the bowel retractordevice 130 described above except that the central portion 136′comprises a plurality of layers 142 of interwoven flexible strips 138.The bowel portions 8 may be drawn through the openings 139 in one ormore of the layers 142. FIG. 19 illustrates another bowel retractordevice embodiment 150 of the present invention which is substantiallysimilar to the bowel retractor device 140 described above, except thatone of the layers 142 comprises a plurality of interwoven ribbons 128and another layer 142 comprises a plurality of interwoven flexiblestrips 138.

FIG. 20 illustrates another bowel retractor device embodiment 150 of thepresent invention. The bowel retractor device 150 includes a bodyportion 152 that comprises a flexible endless collar member 154 thatdefines an inner area 156. In various embodiments, the flexible endlesscollar member 154 is elongated and is sized to be passed down through atrocar cannula 12 or other opening through the abdominal wall 2. Theflexible endless collar member 154 may be fabricated from, for example,Santoprene, polypropylene, etc. The device 150 further includes aplurality of flexible fingers 156, 160 that protrude inwardly from theendless collar member 154. In at least one embodiment, the flexiblefingers 158 extend between fingers 160 and have a cross-sectional sizethat differs from a cross-sectional size of fingers 160. Also in variousembodiments, each of the fingers 158 have a ball-shaped member 159formed on the end thereof and each of the fingers 160 have a ball-shapedmember 162 formed on the end thereof. In at least one embodiment, eachof the ball-shaped members 159 have a diameter that differs from thediameter of the ball-shaped members 162.

The bowel retractor device 150 may be used as follows. After the device150 has been inserted through the trocar 10 or otherwise located at thesurgical site, the surgeon may use graspers or other surgicalinstruments to draw the non-target portions 8 of the patient's bowel 4through the central area 156. Once the non-target bowel portions 8 havebeen drawn between the flexible fingers 158, 160, the surgeon may use agrasper or other surgical instrument to engage the manipulationformation 166 formed on the endless collar member 154 to position and orretain the device 150 in a desired orientation.

FIG. 22 illustrates another bowel retractor device embodiment 170 of thepresent invention. The bowel retractor device 170 includes a bodyportion 172 that comprises a flexible endless collar member 174 thatdefines an inner area 176. In various embodiments, the flexible endlesscollar member 174 is elongated and is sized to be passed down through atrocar cannula 12 or other opening through the abdominal wall 2. Theflexible end less collar member 174 may be fabricated from, for example,Santoprene, polypropylene, etc. The device 170 further includes aplurality of flexible fingers 177, 178 that protrude inwardly from theendless collar member 174. In at least one embodiment, the flexiblefingers 178 extend between fingers 177. The flexible fingers 178 have alength that is shorter than the length of fingers 177. Also in variousembodiments, each of the fingers 177, 178 have a ball-shaped member 179formed on the end thereof. In at least one embodiment, the fingers 177,178 lie along a common plane. Also in one embodiment, a manipulationformation 175 is formed on the endless collar member 174 to enable thedevice 170 to be easily manipulated with a surgical instrument such as agrasping instrument.

The bowel retractor device 170 may be used as follows. After the device170 has been inserted through the trocar 10 or otherwise located at thesurgical site, the surgeon may use graspers or other surgicalinstruments to draw the non-target portions 8 of the patient's bowel 4through the central area 176. Once the non-target bowel portions 8 havebeen drawn between the flexible fingers 177, 178, the surgeon may use agrasper or other surgical instrument to engage the manipulationformation 175 formed on the endless collar member 174 to position and orretain the device 170 in a desired orientation.

FIG. 24 illustrates a bowel retractor device 170′ that is substantiallyidentical in construction and use as bowel retractor device 170 exceptthat device 170′ only has fingers 177 that all have a common length.FIG. 25 illustrates a bowel retractor device 180 that is substantiallyidentical in construction and use as bowel retractor device 170′, exceptthat fingers 177 protrude out of the inner area 176. In particular, theendless collar 174 defines a reference plane “RP” and each of thefingers 177 extend transversely to reference plane RP. The bowelretractor device embodiment 180 depicted in FIG. 25 is substantiallyidentical to bowel retractor device 170′, except that fingers 177 alltaper away from the endless collar 174 in a general frusto-conicalconfiguration. That is, each of the fingers 177 extend along an axesthat will ultimately intersect at a common point. The bowel retractordevice 180′ in FIG. 26 is substantially identical in construction anduse as bowel retractor device 180 except that the fingers 177 extend outof the open area such that they are substantially perpendicular to thereference plane RP and are substantially parallel to each other. Thebowel retractor device 180″ in FIG. 27 is substantially identical to thebowel retractor device 180′ except that the fingers 177 have differentlengths. The bowel retractor devices 170′, 180, 180′, 180″ may all beused in the various manners described above.

FIG. 28 illustrates the use of four bowel retractor devices 190 forsupporting the non-target bowel portions 8 in each of four quadrantsinvolved in the surgical procedure. In at least one embodiment, eachbowel retractor device 190 comprises a flexible pouch 192 that has anopening 194 therein. In one embodiment, the opening is surrounded by acollar member 196 in the form of an elastic band. The pouches 192 may berolled up into a first collapsed position to enable them to be insertedthrough a trocar cannula 12. Once the pouches 192 have been insertedinto the surgical area, the surgeon may open each pouch 192 and installit over a portion of non-target bowel 8. Once the pouches have beeninstalled over the various non-target bowel portion(s) 8, they may beseparated into quadrants which provide the surgeon with physical andvisual access to the target bowel portion. Those of ordinary skill ofthe art will understand that various numbers of pouches 192 may beemployed as needed.

FIGS. 29 and 30 illustrate another bowel retractor device 190′ that issubstantially identical to bowel retractor device 190, except that thecollar member comprises an elastic band 196′ that may be expanded from anon-expanded or collapsed state to an expanded state by inserting aselectively expandable and contractible installation head 193 of aninstallation tool 191 into the opening 194. When the installation head193 is expanded, the elastic collar or band 196′ is retained in theexpanded state to permit the non-target bowel portions 8 to be insertedinto the pouch 192 through the opening 194. Once the non-target bowelportion 8 has been inserted into the pouch, the installation head 193 ismoved to the contracted position and removed from the elastic collar196′ which lightly contracts around the non-target bowel portions 8protruding through the opening 194 to retain the non-target bowelportion 8 within the pouch 192 without damaging the non-target bowelportion 8 protruding therefrom.

The bowel retractor device 190″ in FIG. 31 is substantially identical inconstruction and use as bowel retractor device 190 except that thecollar 196″ is a cinchable member. For example, the collar 196″ maycomprise an expandable belt-type member that may be expanded to form adesired opening and then locked in position by a lock screw 197. Thus,the surgeon may release the lock screw 197 to enable the opening to beexpanded for installation over a portion of the non-target bowel portion8 and thereafter cinched in and locked with locking screw 197 to retainthe pouch 192 on the non-target bowel portion 8 captured therein.

FIGS. 32-36 illustrate another form of bowel retractor device 200embodiment of the present invention. In various forms, the bowelretractor device 200 comprises a body portion 202 in the form of a pouch204. In various embodiments, the pouch 204 may have a cinchable opening206 therein. In at least one embodiment, a closure member 208 isattached to the pouch 204 such that it extends around the opening 206.The closure member 208 may be configured with two diametrically opposedhinge portions 210 that facilitates movement of the closure member 208from a collapsed or closed position (FIG. 33) to an open position (FIG.32). As illustrated in FIG. 32, the closure member 208 may be moved tothe open position by applying opposing forces “F1” on the hinge portions210 as well as applying opening forces “F2” in opposite directions tothe closure member 208. The bowel retractor device 200 may be insertedinto the patient through a trocar 10 as shown in FIG. 34. To facilitateinsertion of the retractor device 200 through the trocar cannula 12, thedevice 200 may be rolled up as shown in FIGS. 34-36. FIG. 37 illustratesanother bowel retractor device 200′ that is substantially identical inconstruction and use as bowel retractor device 200 except that theclosure member 208′ is substantially spring-loaded. Such spring loadingmay be created by the configuration of the closure member itself or beassisted with one or more spring members (not shown) embedded therein.FIGS. 38-40 illustrate another bowel retractor embodiment 200″ that isessentially the same as the bowel retractor 200, except that the closuremember 208″ has four hinge portions 210″.

The closure members 208, 208′, 208″ of the bowel retractor devices 200,200′, 210″, respectively are designed in their normal state to be biasedto a closed position or state. When in the closed state, however, theclosure members 208, 208′, 208″ may be designed to limit the closureforce exerted onto the portion of the bowel received therein to minimizethe risk of occlusion of blood flow to the captured bowel portion aswell as to allow peristalsis to continue. Such closure bias is designedto immediately immobilize the non-target portions 8 of the bowel placedin the pouch so that it does not slip back out. The hinge portions 210,210′, 210″ enable the closure members 208, 208′, 210″ to be forced openfor the entire loading period, or more preferably, the closure membercould be opened only as bowel segments are pulled in. The closureportions then maintain the opening in a closed position while thesurgeon moves to grasp the next section of bowel to be introduced intothe pouch. Thus, use of the biased closed temporary bowel retractordevices 200, 200′, 200″ improve the ease of introducing bowel portionstherein as the closure portions thereof can automatically close itselfto keep the non-target bowel portion from slipping back out of thepouch. The maximum cinching load also prevents inadvertent damage to thenon-target bowel during retraction. In use, the surgeon may insertseveral of the devices 200, 200′, and/or 200″ through a trocar, trocarsor other openings in the patient at the beginning of the surgicalprocedure. Lengths of the non-target bowel portions 8 would be placedinto a pouch and then when the pouch became sufficiently full, theclosure member thereof would be “snapped” shut. This procedure may berepeated with other bowel retractor devices 200, 200′, 200″ as needed.These loaded pouches could then be easily moved from one position toanother in the abdomen cavity during the procedure. The surgeon is ableto easily grasp and move en masse sections of the bowel 4 to move it outof the way. Additionally, the pouches could be temporarily clipped orpinned to different abdomen wall structures to facilitate moreretraction. Also, the various pouch-type bowel retractor devicesdisclosed above may include a grasper access hole through the bottom ofthe pouch to enable a grasper instrument to be inserted therethrough andout through the pouch opening to grasp bowel portions to draw them intothe pouch. Such arrangement serves to facilitate easy introduction ofthe bowel portions into the pouch. The hinge arrangements also serve tobias the closure members closed around the bowel portions as they aredrawn into the pouch.

FIGS. 41 and 42 illustrate another bowel retractor device embodiment 220of the present invention. Various embodiments include a substantiallyelastic body portion 222 that is insertable through an opening in apatient's body to a second expanded position wherein a portion of thepatient's bowel may be supported thereby. In various embodiments, thebody portion 222 includes a central portion 224 that has at least threeflexible first arms 226 that protrude from the central portion 224 in afirst direction. A first opening 228 is formed between each first arm226. In at least one embodiment, each first opening has a shape thatgenerally resembles a portion of an hourglass. In particular, each firstopening 228 has a first neck portion 229 that is narrower than a firstbottom portion 230. As can be further seen in FIGS. 41 and 42, the bowelretractor device 220 further comprises at least two flexible second arms240 that protrude from a second side of the central portion 224 in asecond direction. In one embodiment, each second arm 240 protrudes fromthe center portion 224 at positions opposite to the first opening 228.In other embodiments, the second arms 240 may be aligned withcorresponding first arms 226. A second opening 242 is formed betweeneach second arm 240. In at least one embodiment, each second opening 242has a shape that generally resembles a portion of an hourglass. Inparticular, each second opening 242 has a second neck portion 244 thatis narrower than a second bottom portion 246. In other embodiments, thefirst and second openings may be provided in other shapes.

Various embodiments of the bowel retractor device 220 are fabricatedfrom a foam material or other elastic material. In other embodiments,each of the first and second arms 226, 240 have a bendable wire memberor wire members (nitinal, spring steel, etc.) embedded therein to enablethe arms 226, 240 to be advantageously bent in position to facilitateinsertion of the retractor device 220 through a trocar or other opening.In still other embodiments, the center portion 224 may have a bendablewire portion therein. In other arrangements, bendable wires may beembedded in the center portion 224 and each of the first and second arms226, 240. In other embodiments, at least one bendable wire is embeddedin at least one of the center portion 224, a first arm 226 and/or asecond arm 240. Such arrangements facilitate the bending of the device220 in a position that facilitates its insertion through a trocarcannula. In other embodiments, however, the device 220 may be sized suchthat it can pass through a trocar cannula without having to be bent orcollapsed.

In use, once the bowel retractor device 220 has been inserted into thepatient through a trocar or other opening in the patient's body, thesurgeon may grasp the retractor 220 with a grasping instrument and thenpull non-target bowel portions 8 through the first and/or secondopenings 228, 242. The bowel portions 8 may be held in place bymanipulating the formable arms 226, 240. In various embodiments, asuture drawstring 250 (FIG. 42) is provided to further support and tiedown the retractors position. This step could be repeated several timescreating a grouped clump of small bowel that can be moved around merelyby moving the bowel retractor 220. Various embodiments of the retractor220 can be bent into whatever restraining form would be most useful tokeep the clump out of the working space. It could be lodged up behind atrocar cannula 12 or held back with a grasping instrument 14, whateveris convenient for the specific case. The flexible fit holds the smallbowel together without strangulating it or interfering with theperistalsis causing swelling. The fit is tight enough to prevent thebowel from slipping right back out.

FIGS. 43-46 illustrate another bowel retractor device embodiment 260 ofthe present invention. In various embodiments, the retractor 260comprises an inflatable ring 262 that defines an interior area 264. Theinwardly facing surface 266 of the inflatable ring 262 is textured with,for example, dimples 269, etc. The ring 262 is supplied with apressurized medium such as, for example, through a supply conduit 270that is attached to a source of pressurized medium 272 located outsideof the patient's body. See FIG. 45.

To use the bowel retractor device 260, the retractor 262 (in itscollapsed or uninflated state) as well as the supply conduit may beinserted through a trocar 10 mounted in the abdominal wall 2 or it maybe inserted into the surgical site through another opening 5 in theabdominal wall 2 as shown in FIG. 46. Once in position, the surgeon maythen grasp non-target bowel portions 8 with one or more graspinginstruments 14 to pull the non-target bowel portions 8 through theinterior area 264. The surgeon may first inflate the ring 262 prior topulling the non-target bowel portions 8 through the interior area 264 orthe surgeon may pull the non-target bowel portions 8 through theinterior area 264 prior to inflating the ring 262. Once inflated, thetextured surface 266 retains the bowel portions in position. One or moreretractors 260 may be used in the various methods described above toadvantageously provide the surgeon with physical and visual access tothe target tissue during the operation.

The various bowel retraction devices disclosed herein represent vastimprovements over other retraction devices and methods commonly employedwith performing operations on a patient's bowel. Many embodiments may beeasily inserted into the patient through a common trocar cannula. Thedevices are easily manipulatable with common grasping instruments.Several of such devices may be used as necessary to advantageouslylocate non-target portion(s) of bowel in a desired position to providethe surgeon with physical and visual access to the target tissue. Oncebunches of bowel have been gathered together, the bunches may be easilymoved and positioned en masse to a desired location. The retractors maybe easily clipped to portions of the abdomen to hold the retractor inposition if necessary. While the various retractor devices disclosedherein have been described in detail for use in connection with bowelsurgeries, it is conceivable that various embodiments of the presentinvention could also be employed to retract other forms of tissue/organswithout departing from the spirit and scope of the present invention.

Any patent, publication, or other disclosure material, in whole or inpart, that is said to be incorporated by reference herein isincorporated herein only to the extent that the incorporated materialsdoes not conflict with existing definitions, statements, or otherdisclosure material set forth in this disclosure. As such, and to theextent necessary, the disclosure as explicitly set forth hereinsupersedes any conflicting material incorporated herein by reference.Any material, or portion thereof, that is said to be incorporated byreference herein, but which conflicts with existing definitions,statements, or other disclosure material set forth herein will only beincorporated to the extent that no conflict arises between thatincorporated material and the existing disclosure material.

The invention which is intended to be protected is not to be construedas limited to the particular embodiments disclosed. The embodiments aretherefore to be regarded as illustrative rather than restrictive.Variations and changes may be made by others without departing from thespirit of the present invention. Accordingly, it is expressly intendedthat all such equivalents, variations and changes which fall within thespirit and scope of the present invention as defined in the claims beembraced thereby.

1. A bowel retractor device comprising an elastic body that isconfigurable from a first collapsed position wherein said elastic bodyis configured to be fully passed through an opening in a patient's bodyand a second expanded position wherein a portion of the patient's bowelmay be pulled through a central portion of said elastic body in adesired orientation.
 2. The bowel retractor device of claim 1, whereinsaid central portion comprises an elastic flexible film having a firstamount of elasticity and at least one opening therethrough configured topermit a portion of the bowel to pass therethrough and be retainedtherein and wherein said flexible film is coupled to a flexible outerring having a second amount of elasticity that is less than said firstamount of elasticity.
 3. The bowel retractor device of claim 2, whereinwhen said flexible film is in said first collapsed position, saidflexible film is in a substantially twisted configuration and when saidflexible film is in said second open position, said flexible film issubstantially planar.
 4. The bowel retractor device of claim 2, whereinsaid at least one opening comprises at least one expandable opening. 5.The bowel retractor device of claim 4, wherein said at least oneexpandable opening comprises: an elongated slot having two ends; and atleast one additional opening adjacent to each end of said elongated slotand spaced therefrom such that a portion of said flexible film betweeneach said end and each said adjacent additional opening is rupturable.6. The bowel retractor device of claim 4, wherein said at least oneexpandable opening comprises a plurality of rupturable perforations insaid flexible film.
 7. The bowel retractor device of claim 1, whereinsaid central portion comprises an elastic flexible film that has atleast one opening therethrough that is configured to permit a portion ofthe bowel to pass therethrough and be retained therein and wherein saidflexible film is coupled to an outer ring comprising a selectivelybendable member.
 8. The bowel retractor device of claim 1, wherein saidelastic body comprises a flexible outer collar that defines said centralportion and has a flexible cinchable member woven therethrough andwherein said central portion comprises a flexible film having at leastone opening therethrough.
 9. The bowel retractor device of claim 8,wherein said flexible outer collar has a plurality of spaced radiallyoutwardly protruding tabs formed thereon and wherein said flexiblecinchable member comprises a flexible cable woven through the tabs. 10.The bowel retractor device of claim 1, further comprising at least onetether member attached to said elastic body.
 11. The bowel retractordevice of claim 10, wherein said elastic body comprises a flexible platemember having a plurality of openings therethrough and wherein saidplate member has a retention portion protruding therefrom opposite tosaid tether such that said tether may be inserted through a tetheropening in said retention portion.
 12. The bowel retractor device ofclaim 1, wherein said elastic body comprises a plurality ofsubstantially flexible plate members, each said plate member having atleast one opening therethrough and wherein said substantially flexibleplate members are attached to each other in a spaced apart relationshipby at least one flexible strap member.
 13. The bowel retractor device ofclaim 12, wherein said plurality of substantially flexible plate memberscomprises four spaced apart said flexible plate members and wherein onesaid plate member has a retention strap protruding therefrom that isinsertable through a retention opening in a retention tab protrudingfrom another one of said flexible plate member.
 14. The bowel retractordevice of claim 1, wherein said elastic body comprises a flexible meshportion having a plurality of openings therethrough arranged in agrid-like fashion.
 15. The bowel retractor device of claim 1, whereinsaid elastic body comprises a flexible annular ring extending aroundsaid central portion and wherein said central portion comprises aplurality of interwoven flexible members.
 16. The bowel retractor deviceof claim 15, wherein said plurality of interwoven flexible memberscomprises a plurality of interwoven flexible ribbon members.
 17. Thebowel retractor device of claim 15, wherein said plurality of interwovenflexible members comprises: a first layer of interwoven members; and asecond layer of interwoven members spaced from said first layer ofinterwoven members.
 18. The bowel retractor device of claim 17, whereineach said interwoven member has a substantially circular cross-sectionalshape.
 19. The bowel retractor device of claim 1, wherein said elasticbody comprises: a flexible endless outer collar member defining an innerarea; and a plurality of flexible fingers protruding inwardly into saidinner area from said flexible endless outer collar member.
 20. The bowelretractor device of claim 19, wherein each said flexible fingerterminates in a ball-shaped member. 21-32. (canceled)